'I showed how to cut waiting lists to zero - but other surgeons don't want to know'

by JOHN PETRI

Last updated at 10:02 26 June 2007

When John Petri reduced his hospital waiting lists to zero, his patients were delighted, hospital managers sought his advice and Tony Blair sent a team to learn how he'd done it.

A year-and-a-half later none of his ideas has been taken up, and now he is so disillusioned he's leaving the country. Here, he explains what went wrong. . .

Britain is a country I love and I am a great admirer of the NHS. I was born in Italy, but I've swopped my Italian nationality for a British passport and have worked for the Health Service for nearly 20 years.

This is a fantastic country in which to be a consultant because we have more autonomy than in Europe. Yet despite all this, I'm leaving because I can't go on beating my head against a brick wall.

What's driven me out is the total failure of politicians - and doctors - to take the relatively simple steps that could bring down NHS hospital waiting lists.

Cutting waiting lists to 18 weeks is the Government's flagship policy for the NHS.

Two weeks ago the British Medical Association said: "All doctors want to see this become a reality for all patients."

But the whole project is doomed to failure because it ignores the reason those lists are there in the first place.

And that's a tragedy because waiting lists have no place in a rich, advanced country such as Britain.

What are my grounds for saying this? At my hospital trust in Norfolk I brought my waiting list in the orthopaedic department down from one year to zero.

You should have seen the look on patients' faces when I told them there was no wait for hip and knee operations.

What is scandalous is that I first did that six years ago and since then no one has tried to use my approach.

The response from the Department of Health at the time was: "Thank you, but we are already doing all that is necessary."

In 2006 I was invited to meet Tony Blair after I won a Medical Futures Innovation award for cutting waiting lists. I spent half an hour briefing him. He seemed very interested and promised he would send someone from the DoH to investigate my work.

I waited six months. The DoH team looked, praised and went. We have not heard from them again. I also met Patricia Hewitt, now the Health Secretary, who was very enthusiastic and she has, on several occasions when talking to disgruntled surgeons, used my approach as an example of what could be done.

But the surgeons weren't interested. Not a single surgeon has come to talk to me about it. And all the time people are suffering months of unnecessary pain and distress. That is appalling, but I

can't do anything more to prevent it. This is why I'm leaving the UK to become head of orthopaedics at a hospital in Switzerland.

What's so frustrating is that it would take so little to cut waiting lists nationally. We just need to introduce a system that allows surgeons and anaesthetists to work together in a more flexible way.

Such an approach is already used in France, where I spent five years working before returning to work in the NHS in 1994 at James Paget Hospital in Great Yarmouth.

When I returned to the UK, two things struck me immediately. First, British surgeons were doing half as many operations as those I'd been working with at similar sized hospitals in France.

The figures were startling. In one French hospital there were four surgeons and 12 anaesthetists, and each surgeon did 745 operations a year.

At James Paget there were eight surgeons, 23 anaesthetists and 322 operations.

Second, the other surgeons and I spent at least a third of our time idle. Much of the dead time is caused by waiting for the anaesthetist to prepare the patient.

So, like surgeons in hospitals throughout the UK, we'd sit around waiting for our patients, drinking coffee and talking about the need to bring down waiting times.

This is daft. The surgeons are the most expensive part of the system; they cost hundreds of thousands of pounds to train and are well paid.

We have to re-think the way surgeons and anaesthetists work together. For years they have worked as a couple - now they need a divorce.

There are several ways of doing this, all of which are used successfully in other countries. One is to have two operating theatres so that both surgeon and anaesthetist can be working at the same time: while the surgeon is operating on one patient, the anaesthetist is getting the next one ready.

Another way is to have one theatre and two anaesthetists for each surgeon, which speeds up patient preparation and reduces the amount of time the surgeon has to hang around waiting.

A third is to have anaesthetic nurses who work under the supervision of a consultant anaesthetist, preparing one or two patients while the surgeon is operating on a third. That way, one consultant could run three theatres.

I naively assumed that when I found a solution to the problem, everyone would be as happy as I was. But when I sent my proposal to colleagues at the hospital only one surgeon replied, saying it would never work.

However, the management-were obviously interested, because they were under pressure to cut waiting lists from politicians who, in turn, were aware of what a big concern it was to the public. So the chief executive agreed to build a second theatre, which the hospital needed anyway.

Yet even before that was finished I ran a pilot scheme, working with an anaesthetist in a more flexible way.

We'd work slightly longer hours and we wouldn't stick rigidly to the operating order; we'd change it if it speeded things up.

Within a few months I had cut my waiting list from about a year to three weeks. It became clear that the problem wasn't a lack of surgeons; it's that we weren't being used efficiently.

At James Paget, the number of surgeons has doubled over 12 years, yet the number of operations has remained the same.

However, a trial of my method using a second theatre produced these results: during 50 operating sessions, an assistant and I completed 315 operations - while two consultants using the conventional method did 227.

My system allows me to carry out twice as many operations as my colleagues. Half my weekly workload is now taken up with doing operations that are piling up on their lists.

Of course, I was criticised.

When Ms Hewitt spoke in favour of what I was doing, other surgeons ridiculed it as "conveyor belt surgery".

That annoyed me: the implication, despite the success of this approach in other countries, was that I didn't care enough about my patients and that what I was doing was unsafe.

Dual operating, as it's called, is not new and there is no evidence to suggest it is more risky. The objections were just an excuse for failing to engage with the changes.

More telling was the fact that none of my critics came to see how the system worked in practice; they just sniped from the sidelines.

I had zero-interest from surgeons. Just three got in touch last year after the Daily Mail published an article about what I was doing. Yet when I agreed to meet them, they never turned up.

I accept I can be a bit blunt, but that doesn't explain why there was such a failure to follow up on what I was doing.

The fact is that the way the system is set up means NHS surgeons have no incentive to reduce waiting lists. It makes no difference to our income whether we treat five people or 50 in a week.

The Government made a huge mistake by failing to link financial rewards with performance when it renegotiated the consultants' contract in 2004.

Until that happens, people in pain will continue to wait - which is why it's going to be so hard for many hospitals even to hit the new 18-week target.

Not only do surgeons get nothing extra for performing more operations, but cutting down their waiting list means they have less time to treat private patients.

Once you give us a reason to work more efficiently, we will find ways to improve the system. The method I introduced is just one example of what could be done.

At the moment, extra millions are spent trying to bring waiting lists down, using a system that is not designed to do that.

Instead, they could be used to develop new ways of making the system more efficient. We also need to enable consultants to be paid extra for the work on the NHS that they would otherwise do privately.

I have great attachment to Britain and to the NHS. In France, consultants work harder and they have much less power, while the managers have much more.

I would never have been able to try out my system there in the way I have been allowed to in Britain, because the managers would have blocked it. It is better to be a consultant in the UK, but better to be a patient in France.

Sadly, I can't see that changing any time soon, which is why I am leaving the NHS for Switzerland. I'm certainly not going for the money; my basic salary is 40per cent lower and I'm not sure how the top-up payments work.

But there are no waiting lists and they have better resources. The system is different and I'm interested to discover how it works.